More Than Just a Catchy Beat

By Malika Ramani, '21

In the first clip, a man dances in his wheelchair, arms and legs swinging gently. In the second clip, a woman opens her eyes and smiles in awe. In the third, a man starts singing along. These three individuals share something in common: they are all residents in long term care facilities, and they are all listening to music. These are simply a sampling of the many scenes depicted in Alive Inside: A Story of Music and Memory, the 2014 documentary that highlights the work of a nonprofit organization called Music & Memory, [1] whose mission is to train professionals in long term care facilities in music therapy in order to treat patients suffering from Alzheimer’s disease. [2] The documentary has since spurred researchers across the country – including a team at Brown University – to investigate how and why music therapy can successfully reduce agitated behaviors.

Millions of Americans living in long-term care facilities face cognitive and physical difficulties that are exacerbated for residents by the lack of familiar surroundings and faces. Research has demonstrated that music can stimulate deep memories that have not been lost to dementia, enabling residents to be present as well as more social and conversational. A research study published in April of 2018 by scientists at the University of Utah Health revealed that brain imaging scans show many ways in which personally meaningful music provides an alternative route of communicating with Alzheimer’s patients. [2] According to this research, familiar music can facilitate attention, reward, and motivation, making it easier for residents to manage emotional distress. Furthermore, many dementia patients suffer from issues with swallowing, self-feeding, and choking, and the study presents data indicating that the effects of listening to personalized music may extend to an improvement in swallowing for dementia patients, which could potentially diminish residents’ long-term reliance on feeding tubes. 
 
Following the release of Alive Inside, a team of researchers at Brown University’s Center for Long-Term Care Quality and Innovation (“Q&I Center”) set out to discover whether the personalized music therapy promoted by the nonprofit could demonstrate legitimate medical benefits in nursing home populations. Led by Q&I Center associate director Rosa Baier, the researchers initially performed a retroactive study in 2016, comparing outcomes in nursing homes that had already completed the Music & Memory certification program with those that had not. They found that certified facilities did indeed observe an increased number of residents being weaned off antipsychotic drugs as well as an overall decline in the number of residents’ behavioral problems. Yet the study had limitations: the researchers lacked details about the nature of the facilities’ certification process, nor could they identify how many residents had participated and what kinds of music had been downloaded on the residents’ iPods.
 
Thus, the team then launched a project funded by a $3.7 million dollar grant from the National Institute of Aging to further study music’s effects on reducing antipsychotic drug use and improving behavior among nursing home residents. [3] The six-month long program started in January of 2018 and observed 47 residents with moderate to severe dementia receiving Music & Memory therapy in four nursing homes. After identifying patients’ preferred music and loading these selected songs onto individual iPods, the nursing staff at these facilities was trained in how best to provide this unique alternative to medication therapy when residents exhibited agitated behaviors. During the process, the nursing staff members most familiar with the residents were interviewed regarding how often the residents exhibited 29 different forms of agitated or aggressive behaviors. By using the Cohen-Mansfield Agitation Inventory (CMAI) tool in order to quantitatively evaluate these behaviors – different actions receive different point values on the CMAI scale – the researchers calculated a 16% reported reduction in physically aggressive, physically non-aggressive, and verbally aggressive behavior in the patients who had received the therapy. [4]
 
The anecdotal evidence reported by staff members appears even more promising. One resident who typically slept through meals and was hard to awaken began eating entire meals after listening to music for ten minutes beforehand. Another resident who was often anxious began peacefully listening to the music alongside his wife using a headphone splitter, an activity that is now part of their routine when she visits him. The study generated numerous similar stories of residents being calmed by the music and even being reluctant to take the headphones off. Residents exhibited several pleasure-expressing behaviors while listening to the music, including smiling, tapping their feet, singing, and opening their eyes. 
 
Given that there was no control group in the study – in other words, residents who received the music therapy were not compared to those who did not – the researchers cannot establish causality based on these results. In order to determine whether the therapy directly led to this observed decrease in agitated behaviors, the researchers are launching the next phase of the study in the spring of 2019, in which 81 nursing centers will participate. As these scientists continue to explore the complex mechanisms of how music impacts the brain, programs such as Music & Memory will keep on promoting a noninvasive and fun way to improve health and happiness in long-term care facilities.   

Sources: 

​[1] Alive Inside [Internet]. Alive Inside Foundation; 2016 [cited 2018 Nov 11]. Available from: http://www.aliveinside.us/.
 
[2] Music and Memory [Internet]. Music & Memory, Inc.; 2018 [cited 2018Nov11]. Available from: https://musicandmemory.org/.
 
[3] Spanko A. Can Music Therapy Help Improve Outcomes in Nursing Homes? [Internet]. Skilled Nursing News. Skilled Nursing News; 2017 [cited 2018 Nov 11]. Available from: https://skillednursingnews.com/2017/09/can-music-therapy-help-improve-outcomes-nursing-homes/.
 
[4] Researchers to Study Music Program for Nursing Home Residents with Dementia [Internet]. Center for Long Term Care Quality & Innovation. Brown School of Public Health; 2018 [cited 2018Nov11]. Available from: https://www.brown.edu/academics/public-health/research/innovation/news/2018-10/researchers-study-music-program-nursing-home-residents-dementia.